Doctors Disappear

A curious feature of recent U.S. health care reform efforts — easily overlooked amidst the daily media grind of canceled plans, crashing websites and new restrictions — is the irrational belief that we can extend more health care to more Americans while rendering a career as a family physician increasingly unappealing.

Government has grown increasingly entangled in healthcare markets, complicating the working lives of physicians and, in many cases, threatening their bottom line. The result, according to a Deloitte Survey of U.S. Physicians: a growing number of doctors are convinced that “many physicians will retire earlier than planned in the next one to three years.”

My brother-in-law Bruce Woodall, a physician who has worked stateside and in the developing world, gave me another way to understand this response. Those who go into family medicine, he said, often have an independent and entrepreneurial streak. They have visions of owning a family practice one day and aren’t attracted to the idea of simply working for the government. But increasingly, that’s what family medicine in the United States amounts to. The result is that an increasing number of physicians who can leave, do.

Self-interested alarm is a rational response to this trend, since we already face a physician shortage, but so too is moral outrage on behalf of physicians. Medical students work extraordinarily hard for years, risking enormous personal and financial capital to become professional healers. How has the political establishment responded to this courage, perseverance, and sacrifice? By subjecting the working lives of doctors to the regulatory whims of political insiders and bureaucrats.

You could fill an encyclopedia with all the ways this has complicated and restricted the lives of medical doctors, but a particularly salient way is underscored by a physician’s comment in a recent piece from Kaiser Health News:

I’ve participated with Oxford since 1985,” Dr. Paul Orloff, a physician who’s the president of the New York County Medical Society, said of Oxford Health Plans. “They don’t send me a contract every year to sign. They don’t send me the rates. You don’t know the rates. It’s the only game in town, so you sign.

Why is this health insurance provider the only game in Dr. Orloff’s town? Economies of scale likely play a part, but so too do fussy health insurance mandates that differ state to state. Then at the federal level, President Obama and other politicians have blocked legislative efforts to open competition among healthcare plans across state lines.

Their rationale is that interstate competition would free employers to shop across the country for the cheapest, lamest healthcare plan to dump on their employees. Animated by a similar logic, the architects of Obamacare also included provisions in the act to push all of those stingy employers to give their workers more expansive and expensive healthcare plans than before.

But if that economic logic made sense, it would follow that legislators should also pass a federal edict forbidding private employers from cutting employee salaries, while simultaneously pushing them to give all their workers a nice fat pay raise. The reason none of these strategies would effectively promote the common good stems from a stubborn truth of economics: artificially propping up or boosting worker compensation by government edict leaves businesses unable to afford as many workers. The result is unemployment.

Some are further concerned that interstate competition would debase the entire health insurance industry, but think about other industries. Free competition has led to continued improvements in cell phone technology, automobile rental, restaurant service, and on and on the list could go. It’s the difference between the service you get from Apple or Chick-fil-A versus the take-a-number bureaucratic shuffle you experience at the Department of Motor Vehicles. The first two are sharpened by competition, the latter shielded from it.

Yes, employers who come between workers and health insurance providers want good value, but both employer and employee want good value. Neither wants a needlessly large chunk of the employee’s total compensation bled off into overpriced, inefficiently managed health insurance. Both desire the quality and value that free competition tends to promote.

Defenders of government-managed healthcare respond with visions of organs routinely coerced from doe-eyed co-eds and sold to prune-faced zillionaires, as if medical anarchy were the only live alternative. But there’s another option: a market of health insurance providers competing for doctors and patients, and a healthcare culture guided by the rule of law and leavened by that strong tradition of charity that led Christendom to invent hospitals in the first place.

The Affordable Care Act threatens to eclipse that tradition of ordered liberty, a cultural loss we can ill afford.

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